Provider Demographics
NPI:1952401788
Name:VALINS, LISA B (DMD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:B
Last Name:VALINS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213-05 UNION TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11364-3593
Mailing Address - Country:US
Mailing Address - Phone:718-464-0768
Mailing Address - Fax:718-217-5240
Practice Address - Street 1:213-05 UNION TURNPIKE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11364-3593
Practice Address - Country:US
Practice Address - Phone:718-464-0768
Practice Address - Fax:718-217-5240
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044600-11223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01744201Medicaid